Provider Demographics
NPI:1154486579
Name:BALHOFF, DONALD B (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:B
Last Name:BALHOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909-E AMBASSADOR CAFFERY PKWY.
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5236
Mailing Address - Country:US
Mailing Address - Phone:337-761-7070
Mailing Address - Fax:337-761-7171
Practice Address - Street 1:3909-E AMBASSADOR CAFFERY PKWY.
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5236
Practice Address - Country:US
Practice Address - Phone:337-761-7070
Practice Address - Fax:337-761-7171
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics